【作者】 唐健；

【导师】 张金钟；

【作者基本信息】 天津医科大学 ， 伦理学， 2008， 硕士

【副题名】兼评乔治·华盛顿大学医学中心POM人才培养模式

【摘要】 医患沟通作为一种核心的临床能力,以病人中心是其基本价值取向。医患沟通应该在医学教育,特别在医学伦理学教育中占有基础地位,其实现方式应表现为以技能为导向的,结构化的教学与评估。中国在此领域尚处于起步阶段,美国的经验值得借鉴。医患不睦是当下的现实,医患沟通是医学界与社会的共识。医患沟通是医学人文属性和艺术性的体现,是医学实践性和道德性的必然要求。提高与患者的沟通能力,是作为临床医生的道德要求,是医学伦理的实践,是医学专业精神的展现。传统的生物医学模式下,医患沟通侧重对生物医学病史的采集,在学习上主要依靠临床模仿和个人经验的积累;在生物-心理-社会医学模式下,医患沟通更应该侧重对患者全面的关怀。医患沟通,是作为社会人与专业人双重角色中的医疗专业人士,与作为人的病人之间的信息交换的过程,主要表现为临床医生与患者之间直接的信息交流技能。医患沟通,可以划分为临床实践、教育与研究三个分支。本文主要探讨医患沟通的教育问题。第一章,列举了医患沟通在临床实践中所涉及的一系列具体问题,对所探讨的核心问题进行了界定,即医患沟通在医学教育中地位与实现方式,并分析了本文的视角、进路、方法、资源等。第二章主要关注医患沟通在医学教育中的地位。以“李丽云案件”为引子,提出目前临床医生的沟通能力的不足的问题,说明医患沟通教育的必要性,并描述一次利用案例教学法进行临床伦理与沟通的教学实验过程和收获,分析传统的教学方法与沟通教学目标存在的龃龉。最后,述评了医患沟通教育在国际特别是北美地区的研究进展和医患沟通教学的基本理念和共识。第三章,探讨医患沟通在医学教育中的实现方式。首先实地调查分析了美国乔治华盛顿大学医学中心医患沟通教育的开展情况,并重点关注了其特色鲜明的POM医学人才培养模式;接着,从微观上描述了一次对住院医师的伦理与沟通研习课的设计和实施过程,并亲身设计与参与了该研习课中标准化病人的教学环节。最后,对这种美国式的沟通教育模式在中国移植与开展过程中可能要面对的问题进行简要分析,探讨了教学的技术与文化问题。第四章,论证了医患沟通的本质,在于理解、信任和帮助,对医患沟通教育进行伦理学的辩护,指出医患沟通教育的内在价值维度和外在价值维度;提出了应将以病人为中心作为医患沟通教学的基本价值取向,在介评了美国医学会以病人为中心的沟通模式后,阐述了以病人为中心的沟通在中国实践的展望。在本文附录部分将提出沟通教学模块设计作为本研究的一项初步结果。更多还原

【Abstract】 Patient-centered communication is one of the core clinical skills. Skill-based, structured communication teaching and assessing should play a foundational role in modern medical education. American methods could provide us some new perspectives and useful experiences to promote medical communication education in China.With current doctor-patient relationships in tension, communication is becoming one of the social consensuses inside and outside of medical professional community. Medicine not only as a science but also an art, effective and efficient communication is an element of modern medical professionalism. Within traditional biomedical model, doctors always focus on taking biomedical history from patients by interview skills; in biopsychosocial model, providing care should be the main goal of communication.Doctor-patient communication as an information exchanging process in patient care should be skill-based. Medical communication as an academic medical field could be divided into clinical practice, education and research three sections. This research mainly pays attention to communication education.In the first chapter, we define the core research objective and discus the perspectives, methods and academic resources. In Chapter 2, based on the "L.L.Y case" , we clarify the importance of clinical communication competence training to medical professionals. By describing a case-based ethics teaching, we get a conclusion that traditional teaching and assessing methods are insufficient to communication training. At this point, international especially American educational progress is a good model to develop Chinese communication education. In Chapter 3, we explore the rational ways to implement communication in medical education. After observing the POM model at George Washington University Medical Center (GWUMC), and describing the design and implementing of a workshop concerning about how to teach residents clinical ethics and communication skills using standardized patients by American medical educators, we summarize some highlights about the American learner-centered experiential communication learning methods, and rethink how to improve our working in Chinese context. As a primary conclusion in Chapter 4, we explore the philosophy of doctor-patient communication that is understanding, trust and healing.In the appendix, we submit a communication teaching module design as the primary outcome of this research.更多还原